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Studies on Renal Disorders pp 93–104Cite as

Thiamine in Diabetic Renal Disease: Dietary Insufficiency, Renal Washout, Antistress Gene Response, Therapeutic Supplements, Risk Predictor, and Link to Genetic Susceptibility

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Abstract

Thiamine (vitamin B1) has a key role in protection against renal disease by providing the thiamine pyrophosphate cofactor for transketolase and thereby maintaining oxidative and reductive pentosephosphate pathway activities key in countering oxidative and metabolic stress. The link to renal disease is amplified by increased washout and deficiency in renal disease, which in diabetic nephropathy may be linked to tissue-specific downregulation of thiamine transporters. Transketolase is part of the antistress gene response coordinated by transcription factor NF-E2–related factor-2 (nrf2) and activated by dietary bioactive and synthetic activators. Such activators have been found to be beneficial in the treatment of diabetic nephropathy wherein increased transketolase activity may have a key role. High dose thiamine supplements prevented the development of nephropathy in experimental diabetes and in a recent pilot scale trial reversed early stage nephropathy in patients with type 2 diabetes. Transketolase gene TKT variability and increased fractional excretion of thiamine were linked to susceptibility and progression of diabetic nephropathy. A definitive, large-scale trial of thiamine supplements for treatment of early stage diabetic nephropathy is now desirable.

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Acknowledgments

We thank Diabetes UK, Juvenile Diabetes Research Foundation, and the Pakistan Higher Education Commission for support for our thiamine-related research.

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Authors and Affiliations

  1. Warwick Medical School, Clinical Sciences Research Institute, University of Warwick, University Hospital, Coventry, CV2 2DX, UK

    Paul J. Thornalley

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  1. Paul J. Thornalley
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  2. Naila Rabbani
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Correspondence to Paul J. Thornalley .

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Editors and Affiliations

  1. Graduate School of Medicine, Division of Molecular Medicine and Thera, Tohoku University, Seiryo-machi 2-1, Sendai, 980-8575, Japan

    Toshio Miyata

  2. Medizinische Klinik IV, Universitätsklinikum Erlangen, Krankenhausstr. 12, Erlangen, 91054, Germany

    Kai-Uwe Eckardt

  3. Graduate School of Medicine &, Faculty of Medicine, University of Tokyo, Hongo 7-3-1, Tokyo, 113-8655, Japan

    Masaomi Nangaku

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Thornalley, P.J., Rabbani, N. (2011). Thiamine in Diabetic Renal Disease: Dietary Insufficiency, Renal Washout, Antistress Gene Response, Therapeutic Supplements, Risk Predictor, and Link to Genetic Susceptibility. In: Miyata, T., Eckardt, KU., Nangaku, M. (eds) Studies on Renal Disorders. Oxidative Stress in Applied Basic Research and Clinical Practice. Humana Press. https://doi.org/10.1007/978-1-60761-857-7_5

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